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MVMM M M 1=11 11111=1 � � <br /> CHAIN OF CUSTODY RECORD <br /> 4 _ Advanced rate i (7-01 Ole Page —A—�.� <br /> GeciEnvironmental, Inc. ( <br /> 837 Shaw Road-Stockton,California-95215- (209) 467-1006-Fax(209)457-1118 01 - 11s, <br />' Cllerrt ��,{,vCti��(�, ���..�--��- F'ropajManager �i� Tests Required <br /> Phone Numr <br /> cl <br /> S piers (S at e} Invoice <br /> AGE <br /> Project Name , - - ^ Client <br /> f, <br /> Sample Location SampleTYpe No of �J <br /> Date Time Water Solid Notes <br /> Number Description comp arab Air Coats <br /> .0 <br /> A4T <br /> A, <br /> A,Wij?J / � <br /> i guis ab ( iNaturel Receivedy ignalure 5 DatelTim <br /> Relinquished by (Signature) Received by (Signature) Date(Time <br /> Rehnguished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received or Laboratory by L1 DatelTime <br /> Method of Shipmentcb4 <br /> 5peatial instructtons )+ ,�y ! l hereby authorlZ tfi erformanes of the above Indicated work <br />